BLOG #1: Focused Excerpt

BLOG #5F – SENSORY IMPAIRMENTS​In the May 2013 Edition of DSM 5th Edition (DSM-5), the realm of restricted, repetitive patterns of SENSORY behavior, interests, or activities has been expanded to include abnormalities in ‘sensory processing impairments.’ The objective of adding this to the behavioral domain was to help clinicians perform diagnosis more accurately, thus identifying cases requiring treatment with greater accuracy.

The DSM-5 is a living document which provides a common language for clinicians, patients, and researchers to communicate information about symptoms, as well as to accurately diagnose mental, behavioral, and personality disorders. Retrieved from: https://www.steppingstonesca.com/single-post/2016/09/22/A-Quick-Guide-To-The-DSM-5-Criteria

As a parent and/or teacher, you will become a trained observer, learning to recognize ‘sensory impairments’ in your child or student. This in turn, will help clinicians find just the right diagnosis, treatment, and intervention for that child.

Remember that the DSM-5 is a ‘living document’, that is because the ‘bar’ gauging ‘severity’ is forever changing. Your child, student, or patient is also forever changing. As observers, you are identifying the ‘current’ pattern, behavioral crisis, or behavioral activity. Just saying.

The National Institute of Health (NIH) website tells us that maladaptive behaviors such as ‘stereotyped behaviors’, i.e. sensory impairments, are predictable as a ‘severe sensory feature’ of autism. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727194/

Banda, et al. (2014) in a review studies of individuals with Autism and Sensory Impairments, having the overlapping condition/characteristics of sensory impairments. These impairments varied in the levels of severity, as well as the number of impairments; to include – vision, hearing, and/or communication. In addition, four of the studies targeted problem co-existing behaviors such as self-injury, aggression, vocal disruption, and self-stimulatory activity.

Fuentes, et al. (2010) talk about studies using questionnaires which revealed general differences in sensory experience of auditory, visual, tactile, and movement processing in those children with and without Autism. This study noted that there was no significant difference in IQ between the groups.

They found that the sense of position and movement of parts of the body, proprioception, played a crucial role in successfully interacting with the environment. The general tone of responses from study participants was conveyed in these two statements –

“I could not point at objects for many reasons. The most important reason is that I had very little sensation of my body.” (Tito Mukhopadhyay), And, “ In childhood I had real problems in knowing exactly where my connectional limbs and trunk were… where they would move to next, and even more frighteningly, where they had last been positioned.” (Lucy Blackman).

Sensory impairments in the ASD group were significantly worse than those in the group without an autism diagnosis. Researchers said that successful ‘skill’ performance on the PANESS assessment involved good sensory processing and rapid execution of finely controlled movements; such as tool use and skill imitation.

< My Thoughts > “the PANESS assessment…”

​The official title of the PANESS assessment is Positive And Negative Syndrome Scale; Positive meaning ‘productive’ symptoms, and Negative to mean showing ‘deficit’ features. According to an online interview with Lewis Alan Opler, Long Island University, one of the co-authors of PANESS, said that their PANESS assessment is still valid, reliable, and user friendly instrument. An accompanying comment by Bajouco, Hospitais da Universidade de Coimbra, stated that for another assessment of negative symptoms of diminished emotional expression, and motivation/pleasure one could use is the Brief Negative Symptoms Scale (BNSS). Retrieved from: https://www.researchgate.net/post/What_is_the_best_alternative_to_PANNS_in_assessing_psychosis

< My Thoughts > “…assessment of symptoms…”

According to Evans, et al. (2012), symptoms of sensory impairment features can also be categorized by how one responds or reacts to, and ‘novelty awareness’ of, environmental stimulus. A persons’ reactions could depend also on their sensory threshold, temperament, physiology, genetic disposition, or even their environmental parenting. Smiles.

They give an example of how some cannot tolerate the ‘buzzing’ of a computer. That those individuals with highly active self-regulation techniques will simply move away from distressing stimulus.

As a teacher, that could explain why some students cannot tolerate what they hear as the ‘buzzing’ and/or ‘flickering’ of overhead fluorescent lights. Then in Middle School, when the sensory impaired student tantrums after entering ‘computer lab’ we should NOT ask ourselves, “Why?”

Sonny can be rooms away and come ‘tantrumming full out’ the second I turn on the computer. My first thought was that he didn’t want to share my attention with that ‘evil’ computer… but then I realized it had more to do with his intolerance for the computer’s emitting lights and sounds.

Sometimes, I can place an oscillating fan on the floor by my chair and he will accept that as a distraction, but only for a limited time. And, some days his tolerance for the buzzing seems to approach some sort of ‘needed stimulation’ and he likes to stay within the range of the stimulating buzzing. Complicated guy. Smiles.

Denman, et al. (2016) say families of a child diagnosed with autism can find themselves trying to understand their child’s behavior while on the waiting list for ‘formal diagnosis.’ That this ‘parental making sense’ of behaviors effects parenting. They say that confusions can also occur with children who have insecure attachment patterns and sensory impairments.

Also, that it is hard for parents to understand how a slight change in routine can cause a child with sensory impairments to have a ‘meltdown’ in the middle of the street. At the same time, parents are concerned about the need to present a ‘positive identity’ to others; while allowing ‘face saving’ while around friends and family members.

< My Thoughts > What I am offering here is a powerful story which may capture in a moment, what it is like to have this experience. (Child’s Sensory Impairments can look like a ‘bad kid’ or ‘bad parenting’ to outsiders.)

Focused Excerpts from the book (22% indicates location in the Kindle version of the book, instead of page numbers.)

22% I’d stopped at the drugstore to pick up a new prescription for Jaxson, the third in a series of medications to try and help prevent his aggressive behavior, particularly at school.

23% When I am in the store and my child suddenly rolls into tantrum mode, kicking and screaming and such, it’s not very helpful if a passerby says things like, “He needs is a good spanking,” or “You wouldn’t see my kid acting like that.” I want to say, “Go ahead and hit him, see if it works.” Or, “Bye, honey. This nice man is gonna take you home. Have fun…”

Okay, so I don’t actually do this. But I really, really want to.

24% I maneuvered to press Jaxson against the car with my body, fishing for my keys.

It took ten minutes to unlock the door and push my screaming child inside. I closed the door and stood there for a moment, taking a look at the nice bruise on my arm that was already forming, his little teeth imprints clearly in the center.

Suddenly a nice lady handed me the bag I’d dropped and smiled as Jaxson wailed inside the banging on the window, his voice only slightly muffled by the closed windows.

“He’s autistic,” was the only thing I could think of saying. “Yeah, I kind of guessed there was something going on there besides the regular old tantrum.

Can you get home okay?” she asked. My eyes filled with tears. “Yes, thanks. You have no idea how nice it is to have someone not judging me right now.”

“I think I can guess,” she smiled and then left for her car.

That day, I met an angel outside the Rite Aid drugstore.

< My Thoughts > “…You have no idea how nice it is to have someone not judging me right now.”

Again, the the parents in the Hoogsteen & Woodgate (2013) study felt that their community members were unaware and uneducated about the challenged they faced when bringing their child with them when they shopped or visited in the community. Such as when the negative characteristics of autism were displayed,– tantrums, yelling, disruptive behavior, meltdowns, screaming, physical violence towards themselves and others.”

“Most people look at you and they just think he’s a bad kid… because he looks normal.” “What they think they see is bad parenting, a bad uncontrollable child, or just a rude disruption to their shopping experience.

Parents participating in the study shared how difficult it is to feel that they are on their own… that most people out there are so judgmental and frustrating. One parent says “You get home, and you’re just destroyed because it replays in your mind. How do I make them understand?”

Sensory impairments will interact with autism to produce a particularly difficult developmental path. Appropriate support in education, social care, and vocational training is key to a person’s successful outcome. Retrieved from: https://link.springer.com/referenceworkentry/10.1007%2F978-1-4419-1698-3_413

< My Thoughts > “…Appropriate support in education…”​As a teacher, it is difficult, if not impossible to support a student appropriately, when one does not have the full picture (diagnosis) of what is going on with that child. For instance, I know of a child who started Middle School as a visually impaired student, who was placed in a Special Education program because there was no other placement for him.

​As the first semester progressed, the teacher began to understand that the student had other issues impeding his academic progress. But trying to get ‘the powers that be’ to test him for a possible learning disability was nearly impossible. “He’s visually impaired” they said, “of course he is having learning problems.” “Wait! What?” “He can’t have both?” You are professionals, it’s too easy to say that he only has one diagnosis!

Pawletko (2002) tells us that as a former teacher of the visually impaired she was struck by the fact that certain students did not respond to typical interventions. They often engaged in stereotypic behaviors, like also appearing to be deaf. But, she said, rarely was it ever asked, “Could this child also be autistic?”

Focused Excerpts from the book (8% indicates location in the Kindle version of the book, instead of page numbers.)

8% If you have Medicaid you get free evaluations. Check with your state websites to see if your family is eligible for Medicaid and CHIP which provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. There is also the Affordable Care Act of 2010, which expanded Medicaid eligibility in 2014.

< My Thoughts > “Don’t be afraid of the autism label, because it will help you get the services you need for your child.”

Don’t be afraid of the autism label. To get services you must have a diagnostic label and the autism (label) diagnosis gets you more of everything.

As a special education teacher, and before becoming a parent of a child with autism, I felt sorry for those parents who were in denial and could not see the ‘big’ picture. I wanted to take the parent aside and say, “Your child is so far away from hitting any developmental milestones, now or ever. Please…stop being in denial… accept that Autismlabel! Get started helping him!” But of course that would be quite unprofessional of me.

In the classroom, it just gives teachers a perimeter around which to confidently plan lessons and create goals for the child. But those labels throw fear into the hearts of parents. In many cases the child’s growth and progress is just delayed, but in other cases, important milestones may never be met, because someone refused the ‘autism’ label and the services guaranteed by that label. Just saying.

54% Having autism does not mean your son cannot have a fulfilling life; do not allow the language of victimhood into your vocabulary. Use empowering words that teach him that he is without limits.

88% Finally, remember you will need patience and optimism in this journey. Nobody can foretell the path your child will take and the spectrum of outcomes is broad. Take things step-by-step, stay present, and relish each day.=====================Next: BLOG #5G Sensory Responses=====================

BLOG #5J –SENSORY DIET​Nancy Penske may surprise us by saying that the Sensory Diet is actually NOT about food, but about sensory enriched activities to fulfill a person’s sensory needs. Occupational Therapist, Patricia Wilbarger devised a personalized activity plan which was soon called a Sensory Diet Plan. The purpose of this individualized plan, when followed for 10-20 minutes per day, would help to assist with adaptive, positive responses to environmental stimuli. Retrieved from:https://www.sensorysmartparent.com/sensory-diet

These activities are designed to keep the brain’s neuro-chemicals flowing steadily throughout the day to improve learning. But before you can create a Sensory Diet, it helps to know what sensory issues are at risk. Enter the ‘Sensory Profile’ devised by Winnie Dunn. Gay & Baranek (2008) draw the conclusion that Dr. Dunn believed we are ‘seekers’ of sensations in our environment. Dunn believing that understanding how bodies differ, allows for respect and even embracing of those differences in ourselves and others. (The Sensory Profile was discussed in BLOG #5I.)

Sensory enriched activities, aka Sensory Diets help those with Autism Spectrum Disorder which are somewhat predisposed to anxiety created by their many sensory avoidance and arousal issues, according to Rosen, et al. (2016). They feel that anxiety seems to be mostly associated with higher intellectual function and higher social functioning persons. And, that deficits in these areas can be difficult to detect in those with limited verbal ability, as well.

They found that behavioral intervention targeting anxiety should be evidence-based and provided by well-established treatments. Experienced professionals, they say, will be able to distinguish the individual’s current functioning levels and create an affective Sensory Diet.

< My Thoughts > “…Experienced professionals…”

Some of us have a high threshold when sensation seeking, while others of us have a low threshold. How can you tell the difference, or how can you tell if your child is having sensory processing problems? Really, it takes a clinician or team of people in the field to make that diagnosis. Parents can look online for examples of Sensory Profile questionnaires to get some idea of how data collection works for developing a Sensory Diet.

In an article on Sensory Defensiveness – Sensory Processing Disorder (Copyright 2004), author Michelle Morris tells us some of the following about the types of

​Creating a person’s (child, student, adolescent, adult) Sensory Profile may be necessary in order to better understand their behavioral disorders and how that relates to their sensory issues… such as being over-sensitive, under-sensitive, passive, and/or balanced. Persons may become less or more extremely sensitive over time, as a result of many of their experiences and/or interactions; or how they discriminate and regulate incoming sensory information. (3 bears… just right).

Mays, et al. (2011) begins with an example of a completed ‘Teacher Observation’ form used to begin a case study.

The example gives the student’s name, the observer’s name, and the date and time length of the observation.There are 7 choices which the observer may circle to indicate the ‘sensory system(s)’ involved in the behavior they observed at that time. The Sensory Systems are:

Vestibular (sense of movement)

Proprioceptive (spatial body awareness)

Visual (sight)

Tactile (touch)

Auditory (hearing)

Gustatory (taste)

Olfactory (smell)

Next, the observer rates the intensity of the behavior. Rating on a scale of 1 = not intense, to 5 = very intense.The part (s) of the body involved are noted.

The number of these behaviors, per minute, are recorded.

The duration time the person is engaged in stereotypy is recorded.

Then, whether or not the person completed the assignment/participated in an activity, during observation time. YES or NO.There is a place for the observer to include any NOTES for review.=====================SENSORY OBSERVATION FORMStudent: Bobby S.Date: 01-12-2012 Observer: TeacherBehavior: bouncingObservation began: 9:00 am ended: 9:30 amSensory system involved(circle):

Vestibular (movement)

Proprioceptive (pressure)

Visual

Tactile

Auditory

Gustatory (taste)

Olfactory (smell)

Description of behavior: While sitting in a chair or on the floor, Bobby’s torso bounces up & down, repeatedly, with his bottom leaving & returning to the chair/floor.

Intensity (Rate on a scale of 1 = not intense, to 5 = very intense.) 5 Bobby bounces up & down hard enough that the legs of the chair sometimes come off the floor.

Body part: The part (s) of the body involved are noted. Mostly torso, but his whole body moves.

Number of behaviors: The number of these behaviors, per minute, are recorded. Counted 3 different 1 minute intervals –30 per min. /33 per min. /27 per min.

Activity & time duration:The duration time the person is engaged in stereotypy is recorded. Bounced 24 of the 30 min. during Circle Time activity.

Activity or task completed? Did the person complete the assignment/participated in an activity, during observation time? YES or NO.

4. EP-ACTIVITY… Enhanced Perception (EP) activity has emerged as the fourth proposed pattern of sensory response possibly unique to individuals with ASD in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-5). This DSM-5 version of the psychiatric manual is currently used by clinicians for the diagnosis of Autism Spectrum Disorders.

One way teachers are encouraged to present the school curriculum in the classroom, is by addressing the child’s learning styles or preferences. We design lesson plans to reach the basic learning styles of visual (sight), auditory (sound), tactile (touch), & kinesthetic (movement & doing). Added to that, personally I’ve found that students with musical interests tend to learn math concepts more easily. Although, it isn’t always easy to convince a Music Teacher to welcome Special Education students into their classes. Just saying. Smiles.

Hagmann, et al. (2016) believe that their visually enhanced perception may allow for searching superiority by individuals with autism, compared to their typically developing peers. The study found that this enhanced ‘local’ processing was related to both detection and discrimination abilities, including performance on visual search tasks. Persons with these powers of enhanced perception were better at detecting a target in an array of distracters which shared common features, or in disembedding figures quickly and efficiently.

< My Thoughts > “…disembedding figures.”

When hearing about disembedded figures, my mind jumped to the game of ‘Finding Waldo’, or of finding the ‘Hidden Picture’ in the puzzles we love. And, the term ‘local processing, or ‘locally oriented’ brings to mind the idiom… “Can’t see the forest for the trees.” The person with EP will most likely uses their ‘local’ processing to immediately search out the tree. While their peers, without EP, using their ‘global’ processing to automatically see all the trees as a forest. Smiles.

Bouvet, et al. (2013) tell us that persons with enhanced auditory perception possess superior talents and abilities. An atypical pattern of expression resulting in being able to see enhanced perceptual patterns. These can be the discrimination of superior pitch among multiple musical examples. This ability allows for the person to recognize the differences in the increase and decrease in frequencies between two melodies. But, these individuals with superior perceptual processing are NOT always able to filter out auditory information from background noise.

< My Thoughts > “NOT always able to filter out auditory information…”

So this may be like visual pattern discrimination of finding the dark purple letter among the solid black ones. Only, this is auditory pattern discrimination - finding the superior pitch among several melodies with partially 'pitchy' refrains. Smiles.Read More... CLICK here =>

3. SIRS-ACTIVITY c. Seeking Behavior'Sensory seeking' behavior has its own criteria which is the ASD brain craving more sensory stimuli than what it is already getting. But, sensory ‘seeking behavior’ also includes ‘sensory avoidance’ behavior, as you will see.

Sensory Seeking Behavior –Bogdashina & Casanova (2016) introduce us to sensory ‘seeking behavior’ by saying that sometimes the brain just seeks more sensory stimuli, like when we feel more comfortable having ‘white noise’ in the room while we’re reading. Each person it seems has different thresholds for their sensory seeking needs.

The problem comes in when that 'need', or ‘sensory seeking’ leads to inattentive or overfocused behavior, due to the inability of the person to modulate their needs. They say that ‘sensory seeking’, ‘sensory craving’ are very common in autism. This can also seem to be influenced by the person’s high or low energy and/or activity levels.

Typical ‘sensory seeking’ behaviors, as these authors see it, are those seeking sensory input by twirling, chewing, and needing constant auditory input (sounds). In a play setting, the ‘sensory seeking’ child will choose to play roughly with nearby individuals.

Loves loud noises, TV or music volume, crowds and places with lots of action

Problems sleeping

Enjoys strong odors, even unattractive ones

May lick or taste inedible objects and prefers spicy or hot foods

Frequently attempt to engage in rough play, such as wrestling

She suggests that you begin by figuring out what your child craves. Brainstorm with another person who knows your child well (parent, grandparent, caregiver, etc.) so you have a long list. Your list may look something like this: 'blue things', 'ocean sounds', and 'funny faces'. Ask your child, siblings and your child’s friends and teachers what your child likes as well. Determine how you can engage in sensory integration to fit desired experiences into your child's routine.

Sensory ‘seeking behavior’ has its own criteria which also includes ‘sensory avoidance’ behavior. This behavior may preclude persons from a natural social interaction with others, because they tend to avoid some, but not all, of the following sensory experiences; according to Green, et al. (2016) –

Sensory Avoidance Behavior –Tactile avoidance:

Touching or getting too close to someone

Being groomed or grooming self

Going barefoot

Being splashed with water

Rubbing or scratching a spot that’s been touched

Taste/smell avoidance:

Certain foods

Certain tastes

Certain textures or temperatures

Covers mouth or won’t open it

Movement avoidance:

Feet leaving the ground

Heights

Being tipped upside-down

Holds on to things

Auditory avoidance

Distracted by noise (near or far away)

No background noise

Doesn’t respond to name when s/he hears it called

Covers ears

Visual avoidance

Refuses eye contact

Bothered by lights

Concerned with a lot of movement

Covers eyes

Green (2016) goes on to say that atypical responses to sensory stimuli are a new criterion in DSM-5, and using the Short Sensory Profile (SSP) is still acceptable, but that so many things remain to be seen about how to compare and affirm findings. As well as how these altered responses may impact function and participation in learning and daily living; or, how they may change over time.

Amanda Morin (2018) feels that most ‘sensory seekers’ are undersensitive (hyposensitive). They look for more sensory stimulation in order to make them feel less sluggish and more ‘in their bodies’ and ‘in their space’. They may stand too close, keep touching people or objects, like loud noises, and chew on whatever is handy.

Saying that there are also ‘sensory avoiding’ (hypersensitive) kids that experience sensory input more intensely.

They avoid it because it’s overwhelming to them. They may seem timid, be picky eaters, and be fussy about what they wear. They may be able to calm themselves down… or, may have many, many meltdowns, because they cannot cope with tactile, visual, taste, and noise sensitivity.

< My Thoughts > “…fussy about what they wear.”

“Keep your clothes on until Mom or Dad tells you to take them off!” Smiles.

Morin continues, “It’s not always one or the other.” Some kids show a combination of the two reactions, both 'hyper' and 'hypo' reactivity. She says that responses can change based on their level of arousal or ability to self-regulate. That knowing your child’s reactions and triggers can help. Amanda Morin – classroom teacher and early intervention specialist. www.everythingkidslearning.com

Mays, et al. (2011) tell us that it becomes critical for teachers to intervene and decrease or replace self-stimulatory behaviors so the student may attend to instruction and learn new skills.

Bobby’s teacher laments, “He is constantly rocking, flapping his hands, and hopping in his chair!” When a student is engaged in ‘stereotypy’, it can be difficult to gain his or her attention or engage him or her in a learning activity because of the reinforcing nature of the self-stimulatory behavior. Note: One of the defining characteristics of autism is the presence of ‘stereotypy’ behavior. This is a behavior, which when it is repetitive, does not appear to serve a purpose and appears inappropriate for the environment.

This teacher, Mays relates, one day decides to let Bobby jump on the trampoline before reading group. This helps, but still his rocking time is up to 30 minutes. She tries replacing the trampoline jumping with rocking in a rocking chair. This slower, more controlled movement works so well, she lets him sit in it and rock during reading group. He is now completing more assignments and participating in class activities more frequently without rocking.==============NOTE: Next time... 4. EP-ACTIVITY (Enhanced Perception).READ MORE... Click below =>

Raulston & Machalicek (2017) point out that within the repetitive behavior literature, there are generally two categories described – Lower-order: involving motor stereotypy like hand flapping, rocking, lining up toys, or flipping pages of a book; usually found in those very young children. Higher order: including obsessive preoccupation with odd interests and excessive question asking; usually found in those with advanced language skills.

Also, telling us that the latest edition of the Diagnostic & Statistical Manual of Mental Disorders – DSM-5, describes four areas of Restrictive & Repetitive Behaviors (RRB) to include:

Stereotypy – repetitively tapping or banging an object on a surface; clutching, spinning, rolling, moving, or placing objects in a stereotypical manner.

Perseverative interests – uncontrollable repetition of a word, phrase or gesture despite the absence or cessation of a stimulus. Insisting to continue an act or activity without purpose.

Hyper or hypo activity to sensory input or unusual interest in sensory aspects of the environment

They give an example of a child spinning only one wheel of a toy car very closely in front of his or her eyes, over and over again. Thus not engaging in a more appropriate imaginative play or including others; becoming physically aggressive if his or her preferred activity is interrupted or stopped. Parents included in this study commented that these kinds of repetitive behavior were the most difficult aspects of autism for them. And, that they felt higher levels of stress as a result of this behavior.

One of the reasons clinicians say this is an important part of the newer DSM-5 is because it changes how they arrive at an accurate diagnosis for persons with autism.

The Centers for Disease Control & Prevention(CDC) put it this way –

Stereotyped or repetitive motor movements

Insistence on sameness, inflexible patterns.

Highly restricted & fixated interests of abnormal intensity

HYPO (under) or HYPER (over) activity to sensory input

Based on social communication impairments & restricted, repetitive patterns of behavior as noted in the CDC website – https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

In an Overview of Repetitive Behaviors in Autism, expert and parent, Lisa Jo Rudy tells us that repetitive, purposeless behaviors, like lining up toys, spinning objects, or opening and closing drawers or doors can become a problem when getting in the way of ordinary daily activities.

She tells us that the DSM-5 lists abnormal, intense focus on repetitive motor movement of objects, speech and highly restricted fixated interests, or preoccupation with unusual objects. Focus on such things as – ritualized patterns of verbal or nonverbal behavior, flipping objects, echolalia, and/or idiosyncratic phrases. As well as, insistence on sameness; or, inflexible adherence to routines, and extreme distress at small changes. Above text by Lisa Jo Rudy;retrieved from: https://www.verywellhealth.com/repetitive-behaviors-in-autism-260582

< My Thoughts > “…focusing on things…”

Sonny is nonverbal, he makes sounds and laughs, but no language, so all of his repetitive behavior is nonverbal. We purposely give him ‘interactive’ toys so that he can engage in ‘purposeless behaviors’. “Wait, what?” My reasoning is that, much like the autistic child or adult who repeats video scripts as a type of communication, Sonny can use his ‘See and Say’ toy. Of course, this is where the perseverance comes in.

“Someone poisoned the waterhole!” “Someone poisoned the waterhole!” “Someone poisoned the waterhole!”… (Courtesy of Tom Hanks’ voice, Toy Story 3) Sometimes accompanied by Sonny’s laughter… and sometimes by his sounds of frustration if his juice cup is empty.

Pushing the same button, over and over and over, for no apparent reason, can make the listener crazy. But, we have taken a cue from Sonny’s playbook, and just tune out what we don’t want to hear. Or, in the case of some really irritating sounds or phrases we just make a slight adjustment to that ‘See and Say’ button. Sometimes, I laugh, move him over and start hitting the button that yells “HELP MEEEE! HELP MEEEE! Smiles.

What perseverating may look like would be for the child to continue to have an adverse reaction to a noise, an action, or some undesirable stimuli… long after that stimuli has ceased. They may be unable to bring themselves out of prolonged stimming, even though the stimming isn’t calming them.READ MORE... Click below the line =>

In the DSM-5, part of, and listed under Sensory Interests, is Self-Injurious Behavior (SIB). Thompson (2012) states that the most common emergent forms of self-injury are finger, hand, and wrist biting and hitting head with fists or against hard surfaces. Once self-injury becomes entrenched behavior, it is often difficult to eliminate.

A parent reports that there were periods that her son struck his head so hard and so often, it caused severe bruising on the back of his head. His only form of communication, as soon as she gave him what he wanted he stopped.

Often SIBS are found to be included in ‘Challenging Behavior’, or ‘Behavioral Disturbances’ instead of a stand-alone sensory issue. Soke et al. (2017) the reasons may be that studies find both environmental and biological factors have been implicated in studies of SIBs since 1977.

These authors say that generally SIBs are difficult to manage and may result in hospitalizations, exclusion from educational or vocational activities, admission to residential facilities, and even in death. They believe that previous studies are lacking and SIBs have been associated with everything from maternal smoking, sensory issues, gastrointestinal problems, aggression, insomnia, age and gender, severity of co-morbid behaviors; and everything in between.

Chezan et al. (2017) claim that SIBs is a relatively common problem behavior among children with Autism Spectrum Disorder (ASD). This review covers a broad category of problem behaviors, including verbal and physical aggression, property destruction, and tantrums. Severe SIBs require an intervention that is both effective and efficient.

Without effective interventions, they say, it can have a negative impact on children’s quality of life, limiting development and even leading to health-related problems. Interventions have the potential to prevent or reduce the frequency and severity of SIB, but if allowed to persist across time may continue until adolescence and adulthood.

Sicile-Kira (2014) thinks that some children with autism participate in self-aggressive behavior because they could be in pain and don’t have any other way of communication this. She also has seen ASD persons self-injuring in the throes of a PTSD flashback.

She defines SIBs as hitting, biting, head banging, flicking fingers, or slapping oneself as a possible method of sensory seeking stimulation to relieve anxiety, pain, or frustration. Others believe that there is something missing in their diet or something they are getting in their diet that they should avoid.

Those lacking stimulation from their environment may seek it through self-abuse. Some self-abuse is in response to smells, being touched, auditory and visual overstimulation or under-stimulation. Still others believe medication can be found to counteract symptoms.

< My Thoughts > “Others believe medication can be found to counteract symptoms.”

Some of the things that Sonny does, as a result of his autism, is self-injurious behavior (SIBs). With him, this seems to be compulsive, ritualistic, and some sort of stimulation or communication. This was before finding a method of communication and a therapeutic dosage of medication to help him, too. He would strike out to bite or hit himself and others. He would stick a finger in his eye, poking and poking until restrained. When Sonny is under medicated, stressed, and/or can’t get what he wants he will tantrum and bite himself until his needs are satisfied.

He has other undesirable and even dangerous behaviors, which I will not go into here. I’m sure you get the idea of how frightening this can be. The caveat with Sonny is that as well as sad or mad, he can and will often do this self-injurious behavior as a result of being happy and excited about something he’s thinking about or doing. So first, we must stop the risky behavior and then try to find out why. Smiles.

Bogdashina & Casanova (2016) believe self-stimulating behaviors can occur when autistic children are seeking control of their Autonomic Nervous System. One intervention can be a desensitization intervention of the affected areas performed by a qualified and experienced therapist. Another intervention can be exploring deep pressure, squeezing by cushions, or a weighted blanket may help.

They say that when excessive aggression, anxiety meltdowns and panic attacks occur, physical exercise like swinging, climbing, or pushing heavy objects relieve some people. Self-monitoring behavior and other coping mechanisms can be taught for less severe cases of SIBs, to help your child feel safe, trusting their environment.

Sarris (2012) tells parents that early symptoms of autism may be among the most puzzling. Some are barely noticeable, such as response to lights, heat, cold, or physical discomfort. Using their hands or body to manipulate things is not always seen as problematic behaviors.

< My Thoughts > “Some are barely noticeable…”

Sometimes the sensory response causing the self-injurious behavior is an attempt to fix what’s wrong. But often, they don’t know what is wrong or how to fix it. A child who bites themselves because they are too hot or too cold, doesn’t know that putting on or taking off a sweater can make them more comfortable. Of course, trying to get a sweater on or off, may be a challenge of its own! Sonny just reacts as if there is some sort of task assignment taking place. Smiles.

Sarris (2015) cautions that self-injury can persist into adolescence. Violent episodes of challenging repetitive behavior can lead to cuts, bruises, dental problems, and even broken bones, concussions, and detached retinas. She tells how frightening this is because it seems to violate our basic instinct of self-preservation. Those parents are deeply challenged to protect their offspring. They childproof their homes, buckle their seat belts, walk them to school, shielding them from outside harm. But she questions how they can protect them from themselves?

Wright (2018) believes that a behavior consultant is able to offer new insight for the entire family to digest and begin to shift the perspective needed to track and record behavior. An example would be – The family is concerned that Johnny seems to be an aggressive child, frequently hitting those in his environment. Through BEHCA data collection the behavior consultant is able to find that Johnny is NOT doing this on purpose but as a sensory response to his environment. He is also NOT aware of how hard he is hitting.

Taking this further, she says that perhaps Johnny’s behavior is due to his NOT knowing what his body is doing. He is lacking spatial awareness. Or, by slamming his body/arms into things or people, he is seeking sensory input. But, he is NOT intentionally trying to hurt anyone.READ MORE - Click Here =>

Occupational therapists often observe that some children demonstrate extreme behaviors which have been labeled ‘sensory interests’, ‘repetitious’ behavior, and ‘sensory seeking’ behaviors; according to Kirby, et al (2015). Multiple types of behaviors, include – spinning, flapping hands while fixation on spinning objects, fascination with certain noises, interest in bright lights, moving objects, mouthing and smelling objects.

Therapists say that interestingly, 59% of children whom they have observed, did not display many expressions of enjoyment while engaging in sensory activity. Yet, finally considering that few conclusions can be drawn from this about what emotional associations children may have when participating in these sensory activities.

Ausderau, et al. (2014) believe that while for Diagnostic and Statistical Manual of Mental Disorders -5 (DSM-5) define sensory features uniquely and distinctly, they say that –

Their research suggests that certain patterns of HYPO & HYPER activity can co-occur within individuals in reaction to stimulus from the environment. Saying that within each sensory pattern there are underlying concepts. For instance, SIRS activity is characterized by fascination with or craving the sensory stimulation such as with flickering lights or rubbing textures. And, movement, especially jumping up and down, as on a trampoline.

Depriving a person of engaging in intense repetitive behaviors, experts expect may increase anxiety, and depression. This may even cause separation anxiety. Cautioning that those with higher ‘sensory seeking needs’ will often disengage from the behavior more slowly.

These are thoughts I have gathered while pursuing information about ‘sensory activity’ on gossamer wings. Smiles. Sensory activity is considered to be part of:

A biological process

‘Attentional’ disengagement, of sorts

Weak stimulus, creating a strong reaction, and/or

Strong stimulus, creating a weak reaction

Feelings of being overwhelmed by irrelevant stimuli

Change in brain activity, topography, and function

Wigham, et al. (2015) say indications are that intolerance of uncertainty plays an important role in sensory activity. That sensory activity can be ‘heightened and unpleasant’ and/or ‘reduced and under responsive’, alternately. And, that the same modalities can be fluctuating within the individual at any time.

Kirby, et al. (2015) states that a personal account by Naoki Higashida (2013) corroborates an positive affect association of sensory behaviors – “in his book, The Reason I Jump” is because when I jump, it feels so good.”

(7% indicates location in the Kindle version of the book, instead of page numbers.)

7% Ido (pronounced – ee-doh), a 15 year old boy, explains: Imagine being unable to communicate because you have a body that doesn’t listen to your thoughts. Imagine living in a body that paces or flaps hands or twirls ribbons when your mind wants it to be still or, freezes when your mind pleads with it to react.

8% On the outside, the scream came out through his hands, vigorously flapping at the wrists. This was quickly redirected with the command, “Hands quiet.” He was trapped.

< My Thoughts > “…the scream came out through his hands…”

Eventually, because his mother never gave up, Ido learned to communicate through those ‘screaming’ hands onto a letterboard created by Soma Mukhapadhyay. This, he says – “lifted him from darkness.”===============READ MORE... Click here =>

According to Ausderau, et al. (2014), there are four sensory response categories, or sensory patterns. This is about the second one they discussed in their study, Hyper-Activity. ​2. HYPER-ACTIVITY… (overactive), is defined by an exaggerated or avoidant response to sensory stimuli.

Bogdashina & Casanova (2016) describe HYPER-Activity as the channel that is too open, and as a result, too much stimulation gets in for the brain to handle. Continuing to say that children with hyper-activity often ‘stim’ in order to try to normalize their sensory input.

Sometimes they rock, spin, flap, or tap in order to calm themselves. Coping with unwanted stimulation can often result in covering eyes or ears and making noises to block out sensory stimulation.

These authors explain that Hyper-activity is said to be an acute, heightened, or excessive sensitivity to what is going on around in the environment. Under florescent lights such children can see a 60-cycle flickering where the whole room pulsates, as a result. One person said, “My world was fragmented. My mother was a smell, my father a tone, my brother was something moving.” Another said, “I remember being attracted to pieces of people’s faces. Their hair, their, eyes, or their teeth attracted me.” Seeing parts instead of wholes, saying perception is often fragmented, distorted, or delayed.

Phelan (2015) further explains the circumstances of one’s perception. She says that upon hearing a dog bark, many of us pay attention briefly then carry on. But a child having a negative experience with dogs may respond with a startle response, feeling anxious until s/he feels assured they are out of harm’s way. For some with sensory issues, that heightened state of alertness will continue throughout the day.

Bogdashina & Casanova continue, quoting Tito Muknopadhyay who describes his hyper excitable state: “Panic took over my eyes, blinding them shut. It took over my ears, deafening me with the sound of a scream which was my own. I had no power to stop it.”

< My Thoughts > “Coping with unwanted stimulation can often result in covering eyes or ears…”

Ausderau, et al. (2014)believe that while for Diagnostic and Statistical Manual of Mental Disorders -5 (DSM-5) define sensory features uniquely and distinctly, they say that –

Research suggests that certain patterns of HYPO & HYPER activity can co-occur within individuals in reaction to stimulus from the environment.

Donkers, et al. (2015) talk about ‘mismatched’ reactions to environmental stimulus. They say that brain response can cause them to cover their ears because it triggers a memory, not necessarily because the sound is extremely loud and painful.

Neil, et al. (2017) remind us that it is important to choose which behaviors are HYPO and which are HYPER, because measuring and labeling is important to provide funds for various services from insurance companies. This may not optimally account for the full range of sensory symptoms the child is experiencing. For instance, the question may be… “Does your child show an unusual response to…”. The scoring does not divide hypo from hyper responsiveness. Then there is our Sonny who reacts the same for ‘happy’, ‘sad, and ‘mad’! Smiles.

Extended Review with < My Thoughts > by Sara Luker(18% indicates location in the Kindle version of the book, instead of page numbers.)

18% Jack has common self stimulation practices include things like hand-flapping and humming. He tends to gallop across the room with his fingers in his mouth and to grunt or loudly clear his throat. We call it his “zoomies.”

31% “But wait,” Rose said with a worried look. “What if Jack, you know, bounces around? Because of his owt-ism?” Charlie added quietly, “Yeah mom. You know, he has a hard time sitting still. What if he has his zoomies?” “Jack do you need to zoom?” “NO! I WAS STILL!”

We all looked over at him, galloping across the kitchen at that very second. Henry leaped up from his seat and joined his big brother. Together they bounced the span of the kitchen and family room, back and forth, back and forth.

52% “Mom, remember last year at your sister’s party how excited Jack was? He was bouncing from room to room, making his way around the guests as he stimmed and zoomed. Every once in a while he would take his fingers out of his mouth long enough to screech about the dogs getting out.”

“Yes, I watch him every day through the school bus windows, stimming and zooming, eventually taking a seat. By himself.”================READ MORE... Click here =>

The four 'sensory response' categories/patterns, according to Ausderau, et al. (2014), are Hypo-Activity, Hyper-Activity, SIRS (Sensory Interests), EP (Enhanced Perception). My attempt here is to understand them one at a time, starting with BLOG #5H - 1. Hypo-Activity.

1. HYPO-ACTIVITY…(under active), Ausderau finds that the brain is deprived because too little stimulation gets in and the channel is not open enough. The sensory system is under-responsive. Or, the normal processing of smells, sights, sounds, touch, and movement is dulled, under-developed, or processing the stimuli incorrectly.

Always on the move… frequently twirling, spinning, running round & round. Attracted to lights. Rocks back & forth when watching TV. Likes to look at things upside down. No safety awareness. Jumps off furniture & high places; loves the trampoline. Often sudden outbursts of self abuse. Easily vomits from excessive movements. Has difficulty changing body position. Shuts out the world when engaged in body movements. Thinks in movements.

Sabatos-DeVito, et al. (2016) explain that hypo-responsive behaviors are particularly associated with autism and have been reported as early as 9-12 months of age. They also point out that hypo-responsive children may be less sensitive to novelty, thus taking longer to notice and process ‘novelty’ in the environment.

To better understand why taking longer to notice and process ‘novelty’ in the environment can become a critical issue, here is a quote from Evans, et al. (2012) – “Children scoring high on ‘novelty’ awareness tend to be more social, can control impulses, and are better able to comply with tasks they are given.”

As you can see, the hypo-responsive child doesn’t recognize that this ‘novelty’ may be something new and fascinating in their environment. Without being able to peak the child’s interest, the parent, teacher, or clinician will have difficulty finding a teachable moment which can bring the child closer to learning. My own son becomes so fixed on what he is looking at that he refuses to disengage long enough to see a new toy or puzzle. Then when he finally responds, maybe hours later, he gives it the ole periphery look, out of the corner of his eye as he passes by. Smiles.

Author

My purposes are 'educational' in nature. My hope is that this is a place for 'First Responders' and the 'Battle Worn' alike to find information, take solace, and to help one another, in the name of Autism. My commitment is to deliver hope, insight, and a realm of possibilities to all who enter this site.

​Disclaimer: Just to let you know that I, Sara Luker, have put forth my best efforts to create the extended book reviews presented here on this website. I have permission from the authors to publish these Extended Book Reviews. This is just a sharing of stories of those who have gone on before you.

My input as noted by <My Thoughts> are just that... my reflections as a parent, educator, and author. The ideas or considerations presented are given only as hopefully helpful to the viewers relating to the topic or subject.

Any REFERENCES to websites, professional journals, and/or printed material, including eBooks, are solely for educational purposes. I have no involvement in sponsorship or financial interests in these sources.

​Please, understand also that all health matters ALWAYS require professional medical decisions, diagnosis, and treatment by highly qualified and licensed individuals.​Regards,Sara Luker